title: From political controversy to a technical problem? Fifteen years of opioid substitution treatment in Finland.
abstract: BACKGROUND
  The aim of the article is to analyze changes in opioid substitution treatments (OST) in Finland. OST spread in Finland in the late 1990s and early 2000s (Phase 1). Since then, OST has become an integrated part of Finnish drug policy and is provided in various substance abuse treatment units as well as in municipal health centers (Phase 2).
  
  
  METHODS
  The paper analyses the policy around the implementation of opioid substitution treatment in Finland, focusing on identifying the key factors and the relations between them that have contributed to the implementation of OST in Finland.
  
  
  RESULTS
  OST has become accepted in Finland during the past ten years as a crucial element of a harm reduction strategy. Present incentives behind this development are not as clearly related to drug-specific policies as in the late 1990s; rather, they stem from both the restructuring of health care services (e.g. cost-effectiveness) and the strengthening of the medical or technico-administrative approach to the development of OST.
  
  
  CONCLUSIONS
  Since the early 2000s, the development of substitution treatment in Finland has not taken place under explicit drug-political guidance, but largely as a result of many differing intended and unintended effects. One of the unintended effects is the fact that buprenorphine has replaced heroin as the most commonly misused opioid in Finland.
authors.affiliation: Department of Social Sciences and Philosophy, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland. Electronic address: jani.selin@gmail.com.
authors.forename: Jani
authors.initials: J
authors.lastname: Selin
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Hakkarainen
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
authors.forename: Airi
authors.initials: A
authors.lastname: Partanen
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
authors.forename: Tuukka
authors.initials: T
authors.lastname: Tammi
authors.affiliation: National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Tigerstedt
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D003153:Community Health Services / Q000331:legislation & jurisprudence; D055030:Drug Users / Q000331:legislation & jurisprudence*; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D005387:Finland; D033161:Government Regulation; D040261:Harm Reduction; D006291:Health Policy / Q000331:legislation & jurisprudence* / Q000639:trends; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D058850:Opiate Substitution Treatment / Q000639:trends; D011050:Policy Making; D011057:Politics; D012929:Psychological Distance; D011639:Public Opinion; D016320:Substance Abuse Treatment Centers / Q000331:legislation & jurisprudence; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: Drug policy; Finland; Harm reduction; Opioid substitution treatment; Policy window; Psychosocial support